BEUDAMED
    FDA Adverse Event Injury Summary report: N

    RESTORE 4X13 TPS SCREW IMPLANT

    MDR report key: 197802 · Received November 19, 1998

    Report

    Report Number
    2184002-1998-00814
    Event Type
    Injury
    Date Received
    November 19, 1998
    Date of Event
    August 4, 1998
    Report Date
    November 19, 1998
    Manufacturer
    LIFECORE BIOMEDICAL, INC.
    Product Code
    DZE
    Removal / Correction Number
    NA
    Adverse Event
    Yes
    Report Source
    Manufacturer report
    Reporter Location
    OR, US
    Reporter Occupation
    DENTIST

    Narratives

    Description of Event or Problem · 1

    IMPLANT WAS PLACED 01/26/1998 IN SITE #4. IT FAILED TO INTEGRATE AND WAS REMOVED 08/04/1998. ONE PERSON AFFECTED.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    1 RESTORE 4X13 TPS SCREW IMPLANT Implant ENDOSSEOUS IMPLANT DZE LIFECORE BIOMEDICAL, INC. R9020-40-13 75971283

    Patients

    Seq Age Sex Outcome Treatment
    1 61 YR Required Intervention